{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T03:39:51Z","timestamp":1785296391235,"version":"3.55.0"},"reference-count":20,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T00:00:00Z","timestamp":1718064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"Korean Government MSIT","doi-asserted-by":"publisher","award":["NRF-2021R1G1A1013360"],"award-info":[{"award-number":["NRF-2021R1G1A1013360"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objective: Hydroxychloroquine retinopathy, traditionally characterized by parafoveal or pericentral outer retinal damage, is explored for atypical presentations in Asian patients. This challenges conventional beliefs regarding onset, retinopathy pattern, and associated visual field defects. Methods: Ninety-five patients diagnosed with hydroxychloroquine retinopathy at Hanyang University Hospital underwent screening from January 2010 to December 2023. Swept-source optical coherence tomography (SS-OCT), ultra-widefield fundus autofluorescence (UWF-FAF), and automated visual fields (VF) were employed for detailed structural and functional evaluations. Multifocal electroretinography was performed in selected cases requiring additional objective evidence of retinal toxicity. Results: Among 95 patients, 14 (14.7%) exhibited atypical presentations, including very early onset (n = 1), (far) peripheral-dominant damages (n = 4), perivascular involvement (n = 1), bitemporal hemianopsia due to nasal extensive lesions (n = 1), unilateral involvement (n = 2), and asymmetric involvement in retinopathy pattern or severity between the eyes (n = 7). These findings underscore the importance of utilizing expanded imaging techniques, such as ultra-widefield FAF imaging, to identify atypical presentations of retinal involvement. Conclusions: Screening physicians should consider these atypical presentations to ensure timely diagnosis and appropriate management in patients undergoing hydroxychloroquine treatment.<\/jats:p>","DOI":"10.3390\/jcm13123411","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T12:11:00Z","timestamp":1718107860000},"page":"3411","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Atypical Presentations of Hydroxychloroquine Retinopathy: A Case Series Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Jung Min","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyeon Yoon","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4545-8344","authenticated-orcid":false,"given":"Seong Joon","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1016\/j.ophtha.2016.01.058","article-title":"Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy (2016 Revision)","volume":"123","author":"Marmor","year":"2016","journal-title":"Ophthalmology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1097\/IAE.0000000000002408","article-title":"Sequential Changes in Hydroxychloroquine Retinopathy up to 20 Years after Stopping the Drug: Implications for Mild versus Severe Toxicity","volume":"39","author":"Pham","year":"2019","journal-title":"Retina"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.ophtha.2014.07.018","article-title":"Pericentral retinopathy and racial differences in hydroxychloroquine toxicity","volume":"122","author":"Melles","year":"2015","journal-title":"Ophthalmology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1001\/jama.2014.14558","article-title":"Hydroxychloroquine and the retina","volume":"313","author":"Marmor","year":"2015","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.ophtha.2010.11.017","article-title":"Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy","volume":"118","author":"Marmor","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1038\/eye.2016.298","article-title":"Hydroxychloroquine retinopathy","volume":"31","author":"Yusuf","year":"2017","journal-title":"Eye"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"943","DOI":"10.2147\/OPTH.S82398","article-title":"Scotoma analysis of 10-2 visual field testing with a white target in screening for hydroxychloroquine retinopathy","volume":"9","author":"Browning","year":"2015","journal-title":"Clin. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.2147\/OPTH.S66528","article-title":"Test-retest variability of multifocal electroretinography in normal volunteers and short-term variability in hydroxychloroquine users","volume":"8","author":"Browning","year":"2014","journal-title":"Clin. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.2147\/OPTH.S66527","article-title":"Relative sensitivity and specificity of 10-2 visual fields, multifocal electroretinography, and spectral domain optical coherence tomography in detecting hydroxychloroquine and chloroquine retinopathy","volume":"8","author":"Browning","year":"2014","journal-title":"Clin. Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1038\/eye.2011.245","article-title":"Humphrey visual field findings in hydroxychloroquine toxicity","volume":"25","author":"Anderson","year":"2011","journal-title":"Eye"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1111\/bjd.20073","article-title":"New recommendations for retinal monitoring in hydroxychloroquine users: Baseline testing is no longer supported","volume":"185","author":"Yusuf","year":"2021","journal-title":"Br. J. Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1093\/rheumatology\/keab141","article-title":"Baseline retinal testing is no longer recommended for hydroxychloroquine users in the United Kingdom","volume":"60","author":"Yusuf","year":"2021","journal-title":"Rheumatology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1038\/s41433-020-01380-2","article-title":"The Royal College of Ophthalmologists recommendations on monitoring for hydroxychloroquine and chloroquine users in the United Kingdom (2020 revision): Executive summary","volume":"35","author":"Yusuf","year":"2021","journal-title":"Eye"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ajo.2019.09.008","article-title":"Evaluation of Hydroxychloroquine Retinopathy Using Ultra-Widefield Fundus Autofluorescence: Peripheral Findings in the Retinopathy","volume":"209","author":"Ahn","year":"2020","journal-title":"Am. J. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1002\/art.41683","article-title":"American College of Rheumatology, American Academy of Dermatology, Rheumatologic Dermatology Society, and American Academy of Ophthalmology 2020 Joint Statement on Hydroxychloroquine Use with Respect to Retinal Toxicity","volume":"73","author":"Rosenbaum","year":"2021","journal-title":"Arthritis Rheumatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1001\/jamaophthalmol.2014.3459","article-title":"The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy","volume":"132","author":"Melles","year":"2014","journal-title":"JAMA Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1007\/s10384-021-00841-9","article-title":"Ocular findings in Japanese patients with hydroxychloroquine retinopathy developing within 3 years of treatment","volume":"65","author":"Ozawa","year":"2021","journal-title":"Jpn. J. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/ICB.0000000000001393","article-title":"Rapid onset hydroxychloroquine toxicity","volume":"18","author":"Jeltsch","year":"2024","journal-title":"Retin. Cases Brief Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/ICB.0000000000001108","article-title":"Sequential Retinal Thickness Analysis Shows Hydroxychloroquine Damage before Other Screening Techniques","volume":"15","author":"Marmor","year":"2021","journal-title":"Retin. Cases Brief Rep."},{"key":"ref_20","unstructured":"Yoshihara, M.K., and Lui, F. (2023). Neuroanatomy, Bitemporal Hemianopsia. StatPearls, StatPearls Publishing."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/12\/3411\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:56:45Z","timestamp":1760108205000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/12\/3411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,11]]},"references-count":20,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["jcm13123411"],"URL":"https:\/\/doi.org\/10.3390\/jcm13123411","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,11]]}}}